Provider Demographics
NPI:1326096207
Name:LUCAS, MARK S (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:LUCAS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2395 TECH DR
Mailing Address - Street 2:STE 4
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722
Mailing Address - Country:US
Mailing Address - Phone:563-332-9888
Mailing Address - Fax:563-332-9898
Practice Address - Street 1:2395 TECH DR
Practice Address - Street 2:STE 4
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722
Practice Address - Country:US
Practice Address - Phone:563-332-9888
Practice Address - Fax:563-332-9898
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA00445213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0048595Medicaid
IA27214OtherMEDICARE SUPPLIER #
IA0048595Medicaid
IAT01474Medicare UPIN